As soon as someone says “Medicare for All” or “single-payer healthcare” or “universal coverage”, someone else will argue about definitions. And there are important differences.

But today, we are going with what most of us mean when we use one of those phrases: a system of health care under which everyone is covered, however it is paid for.

Most western democracies use some form of this system. As VeryWellHealth explains:

”...several countries have achieved universal coverage, with 100 percent of their population covered. This includes Australia, Canada, Finland, France, Germany, Hungary, Iceland, Ireland, Israel, the Netherlands, New Zealand, Norway, Portugal, the Slovak Republic, Slovenia, Sweden, Switzerland, and the United Kingdom.”

No one in these countries worries that a major illness will bankrupt them as happens in the United States.

Currently, in 2018, about 88 percent of Americans, according to Gallup, are covered to one degree or another depending on what they can afford from private insurers.

Among that number, however, there is one group of people in the U.S. who do enjoy universal, single-player health coverage. It's us old folks, 65 and older. It is of course, called Medicare and as it happens, over the past 15 months I've had a crash course in how it works in real life when something deadly serious comes along.

First, back up to 1965 when Medicare went into effect. I paid into the program from that time forward until I stopped working in 2004. Currently, the Medicare tax is divided between employer and employee, 1.45 percent each.

Many people believe that the Medicare tax covers it and that Medicare, once you are old enough to join, is free. Not so. Use me as an example (this is about traditional Medicare, not Medicare Advantage Plans which I'm not discussing today):

Part A - hospital insurance: free.

Part B – medical insurance: a premium, calculated on income, is deducted from the Social Security (or railroad, etc.) benefit each month. There is a deductible, $183 in 2018. Part B covers about 80 percent of Medicare-approved expenses.

Supplemental (Medigap) coverage: helps pay the 20 percent of medical costs Part B does not. Premiums currently range from about $74 to more than $400 per month.

In addition to all the personal fears and concerns I had when first diagnosed with pancreatic cancer last year, I was terrified at what the surgery and accompanying care would cost me, and if I could even afford it. I decided to deal with after I recovered from the surgery.

What I learned is amazing: Medicare is a whole lot like universal coverage in those other countries: So far, I have paid not a dime for medical treatment.

My biggest expense has been Part D, prescription drugs. Just this month, I finally climbed out of the so-called “donut hole” having paid $5,000 out-of-pocket for drugs this year. I am now in what the program calls “catastrophic coverage” where I pay a small fee for each prescription until next year when the process begins again.

Until I was thinking about this blog post, I had never added up what I pay per year for Medicare coverage. I was surprised to find that the premiums for Part B, Part D and supplemental come to just over $4500 per year.

That sounds like a lot until you know that my treatment costs are, so far, close to $1 million.

Most of the objections to Medicare for All are about cost. I have seen estimates of between $2.4 trillion to $2.8 trillion per year. Who knows if that is anywhere near what the reality would be.

For decades, in certain quarters of the population, a few politicians talked about Medicare for All. Recently, during the 2016 presidential campaign, it was presidential candidate, Bernie Sanders, calling for Medicare for All. The idea began to spread and catch on.

”Right now Democrats are coalescing around a new model for health-care reform. This November’s election could validate it in a way that practically settles the issue among Democrats. That will then determine the discussion in 2020, and in 2021 it could become the basis for a hugely ambitious overhaul of the system.

“Right now we could be witnessing the genesis of one of the most important domestic policy changes in our history.”

Also in April, Democratic Senators Jeff Merkley of Oregon and Senator Christopher Murphy of Connecticut introduced S.2708, the Choose Medicare Act, that would open up Medicare to anyone who wants it and isn’t already eligible for Medicare or Medicaid.

It is such a good idea to just expand Medicare to everyone rather than start of scratch on a new program. The main infrastructure is already in place, it works well, and could be built upon for the entire population.

Of course, the Choose Medicare Act has gone nowhere due to the Republican control of Congress but if there turns out to be a blue wave in the November mid-term election, that bill – or some others with similar intentions - could come to the floor of Congress.

It won't happen that easily or that quickly, but it would be a fine start to the conversation and eventual reality.

Those countries that have had universal coverage for decades pay a lot more in taxes than we Americans do but I sure wouldn't care if everyone could be as free of economic worry as I have been granted, thanks to Medicare, during the wildly expensive treatment I've received.

Most of all, it is the right thing to do. Health care is a human right and the United States, that so glibly repeats that all men are created equal, that the rights of all persons are diminished when the rights of one are threatened, etc. etc., cannot possibly claim those principles if some cannot afford health care.

The United States desperately need this policy change. If you put more than a minute's thought to it, how can we do differently. Are people without coverage or inadequate coverage just allowed to die in the U.S.? I can't find the answer to that question – or maybe it would be too painful to know.

You might want to think about all this as you consider who to vote for in November.

Comments

I had my first encounter with medicare when I was in the hospital 3 days in June -- lots of cardiac testing. Fortunately, not a heart problem. At any rate, I was scared to death of what I would end up paying...even though I also have a good medigap policy.

Like you, I paid ZERO on hospital/doctor bills -- nothing for testing either. When I looked at the detailed billing on the medicare listing, I realized that the state and federal government also set rates for reimbursement via medicare. I was shocked to see that the hospital got about 1/4 what the actual bill was, and had to accept it. My state does apparently set a low rate of reimbursement, and the hospitals are trying to change that. At any rate, I was more than pleasantly surprised.

So yes, 'medicare for all' would work -- and obviously lower costs.

I'm just so glad I finally lived long enough to get medicare! The ten years after my late husband died were a huge struggle to piece together coverage. However, thanks to "Obamacare" I was able to stay covered.

For sure Medicare for All would cost citizens in terms of higher taxes. Rich folk are in love with their tax cuts and will twist what arms they can to stop it. There are two additional benefits:

The Medicare bureaucracy is very efficient. Far cheaper to run than for profit insurance companies. Obviously the insurance companies will have a problem losing business. Doctors would be ecstatic over one set of insurance forms!

Second... businesses in those care-for-all countries do not provide health care benefits for employees. They eliminate that cost and paperwork. Business should be wild about the idea of Medicare for All and I'm puzzled that they are not.

Another obvious... this is medically necessary care... nose jobs and tummy tucks? You're on your own dime.

For a readable and thorough exploration read: The Healing of America by T.R. Reid.

Yes, it can be done, but citizens will have to fight both candidates and powerful lobby groups to get it. As an American who immigrated from the US over 45 years ago, I will say this is an enormous social benefit. Not 100% of it is free (we pay for dental care, vision care unless you have certain conditions, some medications and allied health services), but a damn sight better than being bankrupted by medical bills, or deferring treatment because you can't afford medical care.

Some of my American family members and friends hate their jobs but say they can't quit because of their insurance.

@Trudi: Some Canadian employers provide supplementary insurance to their employees so that they may have coverage for dental, vision care and other services like podiatry. Usually this is a "cafeteria plan" that allows you to choose where to spend your additional benefit. (It is not unlimited.) The really good plans continue this after retirement.

Yes. People are allowed to just die without insurance. ER can't turn away anyone, but that is not a substitute for care. We have all read the shocking stories if patients dumped on the street from a taxi still in hospital gown. Or drug prices so high the patient cannot afford necessary drugs.

These folks have no voice and our media ignores them once the shock value of a particular story wears off, which is in about one hour. Parents of children with cancer diagnoses fight the system, but they can't win either.

I actually read on a health site a few years ago that if people don't want to buy (or can't afford because they are so lazy they won't work) insurance, then they should die.

There are many people who believe that. And they all have employer paid insurance. It is appalling.

When I got my cancer diagnosis in 2015, I was terrified. I figured if the diseased and/or treatment didn't kill me, the bills surely would. But here I am, alive and well and with zero outstanding debt to the cancer center. Medicare is a wonder!!

Charlotte Dahl: It is absolutely untrue that congressmen get free health care. House and Senate members are allowed to buy private health insurance through the Federal Employees Health Benefits Program, as are all federal employees. I've received my insurance that way for years. It is good, but it is not cheap.

As a Canadian, I’d like to add a few comments on our system.
Nothing is free. We pay our entire working life with taxes on our income and, if one has these vices, taxes on alcohol and cigarettes. Very appropriate of course.
I have had occasion to use our medical system extensively through three cancer bouts in my family so Canada lives everyday in my gratitude journal.
That being said, we are encountering a GP shortage because doctors are essentially government employees. They are going into specialties so mostly we’re doing all right there. Some are also emigrating to the US in search of higher incomes.
Our hospitals are not generally as glitzy as yours, but I believe we have all or at least most modern technology within reach of most of our population, remote communities excepted.
I am so grateful to have our system, warts and all. And am content to pay the taxes that are necessary to maintain it.

Dear Ronni, I am 82 and have enjoyed the benefits of Medicare for 17 years. I have been able to afford a supplement to Medicare and so basically all I spend each year is for medications.

So many people seem to be in love with "lower taxes." But taxes are essential for much of what those same people enjoy--good infrastructure, parks, government services. Because people are our greatest asset in this country and because they can die if not taken care of, we must include them in taxes. So to get the care they need--the care I've gotten in Medicare and which they are equally deserving of--we must raise taxes and cover everyone. It is the only truly compassionate---and fair----thing to do.

So I am voting as I have all my adult life for those Democrats who are in favor of Medicare coverage for all. Peace.

The simple fact is that the U. S. already spends lots more on our medical system than all of those countries that have single payer medical. So taxes are not the real issue. It would save money for the government and tons of money for the individual.

So what's the culprit stopping logical legislation? The insurance and pharmaceutical "for profit" industries and their lackeys in Congress.

I had a hard time finding a doctor who would accept Medicare.
So thinking that reimbursement would have to be substantialy increased.
And.... nurses and CNA'S should finally be paid what they are worth.

Charles Krauthammer, one of the more decent conservatives, said a couple of years ago, that he was certain single payer would be in existence within 7 years. His timeline may be off and sadly he's not here to see if his prediction becomes reality. But it is inevitable.

Medicaid is halfway there and many of those most opposed to single payer are recipients of the help offered by Medicaid. Sadly, Democrats need to learn to endlessly repeat the truth about single payer - in very simple terms geared to what they want to hear, so Trump's base can relate.

Yes Yes! to Medicare for all. The administration cost is 3%, far less than for-profit insurance companies who add profit, advertising and inflated CEO salaries to the cost to the client. That said, it is being cut back as we write/read this post. Urge your congressman and senators to oppose all cutbacks to Medicare. It is a good program, most people know about it and look forward to getting benefits when they are old and need care. It does not pay the physicians and clinics enough to survive. My MD told me studies have been done and an office cannot accept more than 20% of patients on Medicare and Medicaid or the office will go broke. Many offices have a limit on Medicare/Medicaid patients and will sometimes accept Medicare/Medicaid and sometimes not depending on their other patient's payment plans. Having one plan for everyone seems fair to me and would drastically reduce the billing, coding staff needed to process insurance claims.
The clinic staff could get down to the work of helping people get better. This legislation would be very popular and would pass if the senators/reps were voting for their constituents instead of campaign funders. Let's keep this idea alive. We may be able to get it done for ourselves and our children.